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Plantumlcloud
filenameClaimStatusStateDiagram.png
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Figure 1. Claim state diagram for the updated claim adjudication process

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  • Contribute to Claim Review Search with Medical Item and Service filters

  • Listening for <<signal_mutation_module_after_mutating>> SubmitClaimsMutation Prepare and prepare the new checked claims for AI categorisation by adding custom fields (i.e. was_categorized)

  • Contribute to Claim Review Search based on the custom fields

  • Defines a scheduled task to convert openIMIS Claims to FHIR Claims and POST to Claim-AI

  • Receive FHIR ClaimResponse

  • Update ClaimItem and ClaimServices status(i.e. was_categorized)

  • Push the claims to Claim-AI module based on scheduled task and/or event based activation and update claims based on the response

  • Reports claim adjudication misclassifications

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